RANKL/OPG系统、Dickkopf-1与类风湿关节炎骨髓水肿的 相关研究

目的探讨以膝关节受累为主的类风湿关节炎（RA）患者骨髓水肿(BME)与核因子-κB受体活化因子配体（RANKL）/护骨素（OPG）系统、Dickkopf-1(DKK-1)的相关性。方法收集我院诊治的以膝关节不适为主诉的RA患者50例，根据MRI检查结果分为骨髓水肿组（BME组，25例）和非骨髓水肿组（非BME组，25例），分别收集其临床症状和28关节疾病活动指数（DAS28），并同期检测其血清OPG、RANKL、DKK-1和血清C-反应蛋白（CRP）、血沉（ESR）、抗环瓜氨酸多肽抗体（CCP）、类风湿因子（RF）水平，比较两组患者之间的差异，并分析RA患者BME与OPG/RANKL系统、DDK-1的相关性。结果与非BME组比较，BME组病程更短（\P=0.000），DAS28评分更高（\P=0.009），CRP（\P=0.000）、RF（\P=0.033）和CCP（\P=0.012）水平更高；且血清OPG水平更低（\P=0.000)，RANKL（\P=0.000)、RANKL/OPG（\P=0.000)和DKK-1（\P=0.001)水平更高；BME组内，BME容积和程度积分与血清RANKL（容积积分\rs=0.31，\P=0.027；程度积分\rs=0.33，\P=0.022）、RANKL/OPG（容积积分\rs=0.29，\P=0.039；程度积分\rs=0.28，\P=0.043）、DKK-1（容积积分\rs=0.33，\P=0.021；程度积分\rs=0.34，\P=0.019）存在相关性。结论 BME是RA患者骨质侵蚀的早期表现之一，伴有BME的RA患者其炎症明显、自身抗体高、破骨细胞更活跃。

英文摘要:

Objective To investigate the correlation of the receptor activator of nuclear factor kappa-B ligand (RANKL)/serum osteoprotegerin （OPG）system, Dickkopf-1 (DKK-1) and bone marrow edema(BME) in rheumatoid arthritis (RA) with the complaint of knee pain. Methods The clinical data of 50 cases of RA with the complaint of knee pain were collected. According to MRI finding, half of them (25 cases) had bone marrow edema（BME）. Each patient received the measurement of serum OPG, RANKL, DKK-1, C-reactive protein （CRP）, erythrocyte sedimentation rate （ESR）, anti cyclic citrullinated peptide antibody （CCP）, rheumatoid factor （RF）. The clinical symptoms, disease activity score 28 （DAS28）, were compared between BME and non-BME groups, and the correlation between RANKL/OPG system, DKK-1 and BME of RA was analyzed. Results Compared with non BME group, BME group had shorter course （\P=0.000）, higher DAS28 score (\P=0.009), CRP (\P=0.000), RF (\P=0.033) and CCP (\P=0.012) . lower level of serum OPG (\P=0.000), higher level of RANKL (\P=0.000), RANKL/OPG (\P=0.000), and DKK-1 (\P=0.001).The severity of bone marrow edema was correlated with the serum RANKL (volume \rs=0.31, \P=0.027; degree \rs=0.33, \P=0.022), RANKL / OPG (volume \rs=0.29, \P=0.039; degree \rs=0.28, \P=0.043), DKK-1 (volume \rs=0.33, \P=0.021; degree \rs=0.34, \P=0.019). Conclusion BME is one of the early signs of bone erosion in RA, there were more active inflammation, autoantibodies, and osteocasts in RA patients with BME.

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